CHINESE ARTICLES & ESSAYS ADVOCATING THE USE OF LI DONG-YUAN'S IDEAS IN MODERN CLINICAL PRACTICE

translated with an introduction by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

The following articles and essays by contemporary Chinese doctors all advance the notion that Li Dong-yuan's ideas about yin fire, the central role of the spleen, and the upbearing of yang are extremely important in treating complex modern diseases. The first two articles are from recent Chinese medical journals, while the third is an essay appearing in The Essence of Liu Feng-wu's Gynecology, also published by Blue Poppy Press.(From "Zhang Jing-ren's Discussion of Bu Zhong Yi Qi Tang [Supplement the Center & Boost the Qi Decoction]" by Zhang Cun-jun, Zhe Jiang Zhong Yi Za Zhi [Zhejiang Journal of Chinese Medicine], #9, 1996, p. 389-390)

Bu Zhong Yi Qi Tang was created in the Jin-Yuan [dynasties] by the famous doctor, Li Dong-yuan (1180-1251 CE). This formula boosts the qi and upbears yang, [thus] smelting grain like a furnace. Throughout the ages it has been highly recommended as a representative formula for regulating and rectifying the spleen and stomach. Its clinical applications are very broad and its treatment efficacy is definite. In recent years, it has been seen more and more in both internal and external medicine. Elder-born Zhang Jing-ren has researched this formula thoroughly, analyzing Dong-yuan's line of reasoning in combination with [his own] clinical application, and his opinions and methods are presented below.

THE PURPOSE OF THE ESTABLISHMENT OF THIS FORMULA

Bu Zhong Yi Qi Tang first appears in the middle juan of Li Dong-yuan's Nei Wai Shang Bian Huo Lun (Treatise on the Discrimination of Internal & External Damages), published in 1247 CE, and appears again in the middle juan of his Pi Wei Lun (Treatise on the Spleen & Stomach), published in 1249 CE. Previously in our country, it has been said in a great many famous formulas and prescriptions collections that this formula comes from the Pi Wei Lun, but this is not absolutely correct.

In order to understand the purpose of the creation of this formula, it is first necessary to understand Dong-yuan's original idea. Below is a brief statement of a few points necessary in order to understand the significance [of this formula].

Central qi: Central refers to the middle burner. Because the spleen and stomach are both located in the middle burner, therefore the central qi and middle burner are synonymous with the spleen and stomach qi.

Stomach qi: The Nei Jing (Inner Classic) says, "In humans, the stomach qi is the root." Dong-yuan believed that, "Since humans live because of the receipt of water and grain qi, what is called the clear qi, constructive qi, defensive qi, and life-upbearing qi are all [only] alternate names for the stomach qi." (Nei Wai Shang Bian Huo Lun) This can be understood [thus]: The clear qi refers to the qi of the finest essence of water and grains. The defensive qi and constructive qi both are engendered from water and grains, which have their source in the spleen and stomach. The first [part] issues from the upper burner and [then] moves outside the vessels. Its nature is extremely bold. The latter [part] issues from the middle burner and moves within the vessels. Its nature is refined. The life or vitality-upbearing [literally, spring-upbearing] qi is also the clear essence of water and grains which is so spoken of because of its ability to upbear and effuse. Therefore, the source of all these qi is the middle burner/spleen-stomach, the place where water and grains are transformed and engendered. Hence Dong-yuan called this "stomach qi."

Yin fire: In the Nei Wai Shang Bian Huo Lun it says:

If the spleen and stomach are vacuous and debilitated and the original qi is insufficient, heart fire becomes exuberant by itself. Heart fire is a yin fire. It arises in the lower burner and is connected with the heart. But the heart does not govern it; ministerial fire does. Ministerial fire is the fire of the lower burner wrapper network vessels1, the enemy of the original qi. Fire and the original qi can not both exist [in the same place]. If one conquers, [the other] one loses.

In terms of understanding [the concept of] "yin fire", throughout the ages there have been various opinions, and there is no agreement as to which is the right one. Dong-yuan himself did not clearly explain the concept of "yin fire." However, in the source text, heart fire corresponds to sovereign fire. When he said, "heart fire is yin fire which arises from the lower burner", he was referring to ministerial fire. If sovereign fire is not bright, ministerial fire will tend to be exuberant and will take its place. Therefore, when Master Li spoke of "yin fire" he was referring to ministerial fire. Ministerial fire and the original qi have a mutually antagonistic relationship. If the original qi is full and abundant, ministerial fire is restrained and constrained and each can fulfill their [own] function. This is what is meant [by the saying], "Qi feeds the small fire; the small fire engenders the qi." If the original qi becomes insufficient, ministerial fire will leave its place and stir frenetically, resulting in the onset of pathological changes. Therefore, it is said:

If the spleen and stomach qi is vacuous, this leads to [dampness] pouring downward to the kidneys. [In that case,] ministerial fire obtains reason to assail earth's position... Hence yin fire penetrates upward. This leads to a rise in qi and panting with bodily vexatious heat...

If spleen and stomach qi pours downward, grain qi cannot obtain upbearing and floating. Therefore, the cause of engenderment and growth cannot move. There is no yang in order to guard the constructive and defensive and the skin cannot resist wind and cold. This engenders cold and heat and results from insufficiency of both spleen and stomach qi.

This clarifies that, if eating and drinking, taxation and fatigue, or other such causes result in detriment and damage to the spleen and stomach central qi, yin fire will blaze and become exuberant and this pathophysiology will result in disease.

Treatment methods: In terms of the treatment of febrile diseases resulting from qi vacuity, Dong-yuan clearly referred to this when he said:

Use sweet warm prescriptions to supplement the center and upbear yang [with] sweet and cold to drain fire. This leads to healing. The Nei Jing says, for taxation, warm; for detriment, warm.2 Because warming is able to eliminate fire and heat, it is greatly prohibited to [use] bitter, cold medicinals, which drain stomach earth. This is what Bu Zhong Yi Qi Tang is for.

It may be asked, what medicinals did [Li] categorize as cold? Radix Bupleuri (Chai Hu) is bitter and cold and lightly lifting. It upbears clear yang and does not drain stomach earth. Radix Astragali Membranacei (Huang Qi) ad Radix Glycyrrhizae (Gan Cao) are sweet and warm medicinals which are used at the same time. Hence there is sweet and cold but not overly bitter and cold. Rhizoma Cimicifugae (Sheng Ma) is categorized as a sweet, bitter, and slightly cold ingredient. It also is based on the concept of sweet and cold draining fire.

FORMULA ANALYSIS

Bu Zhong Qi Qi Tang is composed of: Radix Astragali Membranacei (Huang Qi), 1 qian, Radix Glycyrrhizae (Gan Cao), five fen (mix-fried), Radix Panacis Ginseng (Ren Shen), three fen (remove the crown), Corpus Radicis Angelicae Sinensis (Dang Gui Shen), one fen, Pericarpium Citri Reticulatae (Ju Pi) two to three fen, Rhizoma Cimicifugae (Sheng Ma), two to three fen, Radix Bupleuri (Chai Hu), two to three fen. Rhizoma Atractylodis Macrocephalae (Bai Zhu), three fen. (In the Song and Jin dynasties, one liang equaled 37.30 grams.) Taken as a whole, this formula was composed of sweet, warm, qi-boosting medicinals and yang-upbearing, heat-clearing medicinals. In later times, Rhizoma Zingiberis (Jiang) and Fructus Zizyphi Jujubae (Zao) were also added to this formula.

In the Yi Zong Jin Jian (Golden Mirror of Ancestral Medicine) [chapter titled] "Treatise on Various Doctors' Draining & Supplementing Formulas", Ke Qin says:

As a result of taxation and fatigue or bodily debility, [there may be] diminished qi and yin vacuity engendering internal heat. The exterior manifestation of this are rather similar to an external affliction. In terms of this, Dong-yuan knew that taxation and fatigue damage the spleen and grain qi [in that case] cannot [make] yang qi prevail. It falls downward into the yin and [results] in fever. This is controlled by the methods of supplementing the center and boosting the qi... Based on the Nei Jing saying, "For taxation, warm, for detriment boost", bitter, cold medicinals are greatly prohibited. Rather, one should use sweet, warming ingredients to upbear yang. This will cause yang to be out-thrust and the life-upbearing [qi] to be engendered. When the spleen and stomach are both vacuous, the lung qi is the first to expire. Therefore, Astragalus is used to defend the skin and hair and impede [i.e., close] the interstices. Thus there is no cause for spontaneous perspiration. If the original qi is insufficient, there will be lazy speech and panting. Ginseng supplements this. Mix-fried Licorice is sweet. It is in order to drain heart fire and eliminate vexation. It supplements the spleen and stomach and engenders the qi. These three flavors are sagelike medicinals for eliminating vexation. They are assisted by Atractylodes in order to fortify the spleen and Dang Gui in order to harmonize the blood. If qi is chaotic in the chest and clear and turbid are mutually mixed up, Citrus is used to rectify this. It also scatters stagnation due to sweet medicinals. If the clear qi within the stomach falls downward, Cimicifuga and Bupleurum's light qi and thin flavor are used to lead the stomach qi to soar upward, thus returning it to its root place. These also enable upbearing and floating in order to move the cause of engenderment and growth...

Master Ke completely understood the rationale for the formula Bu Zhong Yi Qi Tang. The key points of Dong-yuan's theory are epitomized in the sayings, "If yang qi falls downward, yin fire will assail above" and "Fire and the original qi cannot both exist [in the same place]; if one prevails, the other loses." Treatment [of this condition] hinges on "boosting the original qi". If the original qi is effulgent, yang qi is automatically upborne and yin fire is downborne. This is what Dong-yuan advocated as the "sweet, warming, heat-eliminating" method.

ESSENTIAL POINTS IN PATTERN DISCRIMINATION

The functions of Bu Zhong Yi Qi Tang are that it supplements the center and boosts the qi, upbears yang and lifts the fallen. The scope of its clinical application is relatively wide. Its essential disease mechanisms are taxation and fatigue damaging internally. Thus the qi of the middle burner spleen and stomach is vacuous and weak. Engenderment and transformation lose their source and this results in a decline of organic function. If severe, the visceral qi falls and cannot lift. The clinical manifestations are a white facial complexion, shortness of breath, dizziness and vertigo, decreased eating, abdominal distention, loose stools, enduring diarrhea, enduring dysentery, frequent, numerous urination, anal prolapse, flooding and leaking, uterine prolapse, a heavy sagging below the navel in the abdomen. The tongue color is pale and the tongue may be possibly fat with teeth marks on its edges. The pulse is fine and weak or soggy and fine.

The key points of pattern discrimination can be divided into two groups of symptoms:

1. Spleen-stomach qi vacuity symptoms: Spleen-stomach qi vacuity leads to loss of fortification of movement and transformation and insufficiency of the source of transformation. Qi and blood production declines and is scanty. One can see dizziness, a white facial complexion, shortness of breath, a low voice, fatigue, scanty intake, abdominal distention after meals, and loose stools.

2. Central qi vacuity fall symptoms: Qi vacuity falls and does not lift. [In this case,] one can see abdominal sagging and distention, possible enduring diarrhea or enduring dysentery, frequent, numerous urination, anal prolapse, flooding and leaking, uterine prolapse, and other such symptoms of the internal viscera descending and drooping.

PERSONAL UNDERSTANDING GAINED THROUGH EXPERIENCE IN ITS APPLICATION

Based on the saying from the Nei Jing, "If the central qi is insufficient, urination and defecation will be changed", if the spleen-stomach qi is vacuous, this will lead to abnormalities of defecation and urination. In either case, this formula is a main one for boosting the qi. If qi vacuity in the elderly leads to frequent urination or incontinence or for pediatric enuresis, add Semen Cuscutae Chinensis (Tu Si Zi), Fructus Rubi Chingii (Fu Pen Zi), and Ootheca Mantidis (Sang Piao Xiao). If there is prostatitis resulting in urinary dribbling, combine this formula with Zi Shen Tong Guan Wan (Enrich the Kidneys & Free the Flow of the Barrier Pills) to treat it. If there is chyluria, combine this formula with Bi Xie Fen Qing Yin (Dioscorea Hypoglauca Divide the Clear Drink) with additions and subtractions. If there is spleen vacuity diarrhea, add Radix Dioscoreae Oppositae (Shan Yao), Semen Dolichoris Lablab (Bian Dou), blast-fried, carbonized Rhizoma Zingiberis (Jiang), and Semen Nelumbinis Nuciferae (Lian Rou). If there is geriatric constipation, one can add ingredients that moisten the intestines.

In clinical practice, this formula can effectively treat conditions which appear to be mutually opposite, such as addiction to sleep and insomnia, diarrhea and constipation, dribbling urinary block and frequent urination, high blood pressure and low blood pressure, as long as their disease mechanisms are central qi insufficiency and qi vacuity falling downward.

In terms of the prohibitions regarding the clinical application of Bu Zhong Yi Qi Tang, these include liver yang hyperactivity and exuberance headache and dizziness, red face and red eyes. In addition, if there is chest oppression and scanty intake with slimy, yellow tongue fur and simultaneous damp obstruction, a reduced amount of Astragalus should be used, or Rhizoma Atractylodis (Cang Zhu) should be added and used together with Atractylodes Macrocephala. This can moderate and harmonize Astragalus's slimy supplementation. In addition, if there is yin vacuity with floating yang or blood stasis, one should also not use [this formula] by reading item by item from the book [i.e., unmodified].

The following article discusses Fu Qing-zhu's use of Li Dong-yuan's ideas. Fu Qing-zhu is the most famous premodern Chinese gynecologist, and his Fu Qing Zhu Nu Ke (Fu Qing-zhu's Gynecology) is the most famous Chinese medical book on this specialty. An English language translation of this book is also available as part of Blue Poppy Press's Great Masters Series. (From "An Exploration of the Fu Qing Zhu Nu Ke [Fu Qing-zhu's Gynecology]'s Application of the Great Method of Upbearing Yang" by Li Zhi, Gao Ji-ning, & Liu Zhi, Si Chuan Zhong Yi [Sichuan Chinese Medicine], #5, 1998, p. 5-6)

The Fu Qing Zhu Nu Ke is based [primarily] on the three viscera of the liver, spleen, and kidneys. It emphasizes banking and supplementing the qi and blood and regulating and rectifying the spleen and stomach. It also advocates the simultaneous use of attacking and supplementing. Master Fu completely studied and thoroughly understood Li Dong-yuan's methods of fortifying the spleen and upbearing yang. He also made new developments to this line of thought, originating the concept of lifting the lungs and upbearing the liver which were new methods of upbearing yang. Below is a brief exploration of Master Fu's methods of upbearing yang.

1. Upbearing yang & stopping bleeding method
Upbearing yang and stopping bleeding is used in [cases of] liver-spleen qi vacuity fall with blood not being managed and contained. For instance, Sheng Ju Da Bu Tang (Upbearing & Lifting Greatly Supplementing Decoction) treats high years [i.e., elderly] blood flooding whose clinical symptoms are excessively profuse bleeding which is pale in color and thin [or dilute] in consistency, generalized lack of strength, a pale tongue, and a fine, weak pulse. This pattern is categorized as liver-spleen qi vacuity downward falling with the constructive and blood not obtaining gathering [or return] to the viscera. The medicinals used which supplement the qi and upbear yang qi are Radix Astragali Membranacei (Huang Qi), Radix Panacis Ginseng (Ren Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Radix Glycyrrhizae (Gan Cao). These are assisted by Radix Angelicae Sinensis (Dang Gui) and cooked Radix Rehmanniae (Shu Di) which supplement the liver and nourish the blood. They are combined with Rhizoma Cimicifugae (Sheng Ma) and Radix Ligustici Wallichii (Chuan Xiong) which supplement the qi of the liver and spleen in order to secure the root and contain the blood, thus vigorously coping with qi and blood fall and desertion. These are also combined with Herba Seu Flos Schizonepetae Tenuifoliae (Jing Jie) and Radix Angelicae Dahuricae (Bai Zhi) which secure, astringe, and stop bleeding. These course obstruction at the same time as helping the previous medicinals upbear the liver and spleen and stop bleeding. When combined with Ligusticum Wallichium, these insure that there is neither stirring of blood nor retention of stasis. Then, in order to prevent stopping, upbearing the clear, warming, and drying from being overly excessive, Rhizoma Coptidis Chinensis (Huang Lian) and Tuber Ophiopogonis Japonici (Mai Dong) added to clear heat and moisten dryness so that supplementation does not cause harm. Thus the formula as a whole mainly upbears yang and stops bleeding. [However, it also] boosts the qi and nourishes the blood, stops bleeding and scatters stasis, and warms and upbears without being drying. Clinically, it is definitely quite effective for stopping bleeding.

2. Upbearing yang & downbearing turbidity method
Upbearing yang and downbearing turbidity is suitable for use in [cases of] qi vacuity downward fall with clear yang not being upborne, while turbid qi is not being downborne. For instance, Master Fu's Jia Wei Xiong Gui Tang (Added Flavors Ligusticum & Dang Gui Decoction) treats postpartum uterine non-contraction or birth door non-closure. The symptoms seen are lower abdominal emptiness and cold, bodily fatigue, lassitude of the spirit, scanty eating, loose stools, a pale white tongue, and a fine, weak pulse. This disease is due to liver-spleen qi and blood dual vacuity with clear yang not being upborne and turbid qi losing its downbearing. Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), Radix Angelicae Sinensis (Dang Gui), and Radix Glycyrrhizae (Gan Cao) are the medicinals which are used which supplement both the qi and the blood of the liver and spleen. These are combined with Rhizoma Cimicifugae (Sheng Ma) and Radix Ligustici Wallichii (Chuan Xiong) which upbear and supplement the clear qi of the liver and spleen. If the clear qi is upborne, then the turbid qi will obtain downbearing. Within this group [of medicinals] is the wondrous [also clever or subtle] one flavor of Ligusticum Wallichium which simultaneously has the various functions of supplementing the liver, upbearing the liver, soothing the liver, scattering stasis, and guiding to the channel. Because of stomach center turbidity having lost its downbearing, Rhizoma Pinelliae Ternatae (Ban Xia) is added to harmonize the stomach and downbear turbidity. It assists the previous medicinals to upbear the clear and downbear turbidity. Hence the lower abdomen is disinhibited and the source of the jade gate's contraction and closure is restored. [Then,] in order to prevent the above warming, scattering, and attacking medicinals from damaging the righteous qi, Fructus Schisandrae Chinensis (Wu Wei Zi) is added to constrain and restrain the righteous qi. When this is combined with Ligusticum Wallichium, it also prevents retention of stasis. This [formula] mainly upbears the clear and downbears the turbid, attacking and supplementing at the same time. It is a good formula for treating uterine birth passageway dysfunction.

3. Upbearing yang & supplementing the qi method
When there is qi vacuity and blood debility with yang qi unable to upbear and lift, qi vacuity is even more greatly aggravated. If one wishes to quickly supplement the qi, one must first upbear yang. Then the formula can get its effect. As [Master] Fu said:

If the lungs have lost their qi and there really is no power to raise and take up, where can one obtain the qi to quiet vacuity desertion? If one has lost qi, then one must raise the qi, and, in order to raise the qi, one must supplement the qi.

Raising the qi is the same as the method of upbearing yang. For instance, [Master Fu] used Jiu Tuo Zhi Mu Tang (Rescue Desertion & Treat the Mother Decoction). [Within this formula,] cooked Radix Rehmanniae (Shu Di), Fructus Corni Officinalis (Shan Zhu), and Fructus Lycii Chinensis (Gou Qi) greatly supplement the essence of the liver and kidneys. After that, [one must] greatly boost the lung qi by adding Cortex Cinnamomi Cassiae (Rou Gui) which supplements the lifegate and upbears yang. Thus the qi is made to have a root, and Radix Panacis Ginseng (Ren Shen) can assist in engendering the qi.

4.Upbearing yang & securing desertion method
Upbearing yang and securing desertion is suitable for postpartum blood flooding and dimming conditions [i.e., faintness and dizziness]. As Master Fu said:

When women have one hour of blood flooding, the two eyes are black and dark. There is dimness and dizziness and lack of consciousness of human affairs and the person does not say anything...

[In that case,] the formula to use is Gu Ben Zhi Beng Tang (Secure the Root & Stop Bleeding Decoction). Within this formula, a heavy [dose] of cooked Radix Rehmanniae (Shu Di) is used to supplement the blood, while Radix Angelicae Sinensis (Dang Gui) harmonizes the blood. Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Astragali Membranacei (Huang Qi), and Radix Panacis Ginseng (Ren Shen) are added to supplement the qi, upbear yang, and secure desertion. Dry Rhizoma Zingiberis (Gan Jiang) is in order to secure yang, upbear yang, and stop bleeding. What's wondrous [or subtle or clever] about this whole formula is that it does not just stop bleeding, it also supplements the blood. It does not just supplement the blood; it also supplements the qi. And it also does not just supplement the qi but supplements fire and upbears yang.

5. Upbearing yang, securing & astringing method
Upbearing yang and securing and astringing is suitable for spleen vacuity qi fall and the two excretions slippery, deserting, and not prohibited. For instance, Master Fu used Jia Wei Bu Zhong Yi Qi Tang (Added Flavors Supplement the Center & Boost the Qi Decoction) to treat postpartum diarrhea, dysentery, slipperiness, desertion, and lack of prohibition, i.e., desertion of the anal door, with a pale tongue and soggy, moderate [slightly slow] pulse. Bu Zhong Yi Qi Tang as a whole fortifies the spleen and upbears the clear. To this is added Radix Auklandiae Lappae (Mu Xiang) to regulate and rectify the spleen qi. Semen Myristicae Fragrantis (Rou Guo) is added to astringe the intestines and stop diarrhea. When all these medicinals are combined, the spleen is fortified and the clear is upborne, the qi is regulated, and the intestines are secured and astringed. Thus this is a good formula for the treatment of postpartum vacuity diarrhea.

6. Upbearing yang & transforming stasis method
Master Fu used the upbearing yang and transforming phlegm method in [cases of] qi vacuity downward fall with simultaneous static blood. For instance, he used Bu Qi Sheng Chang Yin (Supplement the Qi & Upbear the Intestines Drink) for the treatment of rectal birth intestine descension. The symptoms of this condition are a sagging pain in the lower abdomen, lassitude of the spirit, fatigued limbs, a pale tongue, and a fine, choppy pulse. This pattern is categorized as liver-spleen qi vacuity downward fall with simultaneous stasis obstruction in the lower abdomen. Therefore, in emergency, he used Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), and Radix Angelicae Sinensis (Dang Gui), one liang each. These he combined with Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Cimicifugae (Sheng Ma), and Radix Ligustici Wallichii (Chuan Xiong) in order to greatly supplement the qi and blood, upbear yang and lift the fallen. The subtlety within this formula is that both Ligusticum Wallichium and Dang Gui were used stir-fried in alcohol. This is able to increase the strength of their upbearing yang and transforming stasis. Within this formula, Cimicifuga is used at only one share. This is in order to prevent stasis being upborne [via] the chong [to] the heart. This is based on Master Fu's saying: "When using Cimicifuga, using a little upbears the qi, while using a lot upbears the blood." This formula boosts the qi and simultaneously upbears yang. It supplements the blood and also harmonizes the blood. It is a good formula for treating postpartum intestinal descent.

7. Upbearing yang & disinhibiting water method
Master Fu used the upbearing yang and disinhibiting water method in [cases of] spleen-lung qi fall with water dampness spilling and flooding causing swelling conditions. For instance, he used Jia Jian Bu Zhong yi Qi Tang (Additions & Subtractions Supplement the Center & Boost the Qi Decoction) to treat water swelling during pregnancy. This condition manifests as generalized superficial edema, bodily fatigue, decreased eating, shortness of qi, and pale tongue. This pattern is categorized as spleen-lung qi vacuity downward fall with water's loss of conduction and conveyance. As a whole, this formula upbears and supplements the qi of the spleen and lungs in order to disperse water and recede swelling. Concerning this, Master Fu said:

In terms of Bu Zhong Yi Qi Tang's governing power, its source is its upbearing and lifting of the spleen and lung qi. Within this formula, Sclerotium Poriae Cocos (Fu Ling) is used in relatively heavy [amounts]. When [Poria] is combined with Atractylodes, these two medicinals supplement the qi and seep dampness, disinhibit water and disperse swelling. They are assisted by a small dose of Rhizoma Cimicifugae (Sheng Ma) to make their effect even more outstanding. Taken as a whole, this formula mainly upbears yang and disinhibits water. [However,] it cleverly attacks and supplements and treats both the spleen and lungs simultaneously.

8. Upbearing yang & supplementing the blood method
Upbearing yang and supplementing the blood is suitable in [cases of] qi vacuity downward fall with simultaneous yin and blood insufficiency conditions. Master Fu treated difficult delivery with Zhuan Tian Tang (Turning Heaven Decoction). The symptoms seen were shortness of qi, disinclination to speak, a somber white facial complexion, lassitude of the spirit, fatigued limbs, dizziness of the head, scanty eating, a pale tongue, and a faint, fine, slow pulse. The disease was associated with the birthing mother's natural endowment insufficiency of both qi and blood. Therefore, there was not enough qi to turn the fetus. Hence this formula was used in emergency with large doses of Radix Panacis Ginseng (Ren Shen) and Radix Angelicae Sinensis (Dang Gui), two liang each. These were combined with one liang of Radix Ligustici Wallichii (Chuan Xiong) in order to more vigorously supplement the qi and blood, regulate the liver and fortify the spleen. Hence there was for force to turn the fetus. Within this [formula,] Ligusticum Wallichium also preventively scatters stasis, while as small amount (one fen) of Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi) is added to insure that Ginseng's supplementation of the qi is sufficient. [This ingredient] warms yang and invigorates the qi, frees the flow of the channels and hastens birth. Also within this formula, another clever combination is Radix Cyathulae (Chuan Niu Xi) with Rhizoma Cimicifugae (Sheng Ma). These two flavors respectively downbear and upbear. Hence movement is level [or calm] and not contrary. This combination assists the previous medicinals to turn the counterflow fetal body, thus regulating its position entirely. Although is formula mostly upbears yang and supplements the blood, there is downbearing within upbearing and hard and soft are mutually interdependent. Hence it is a good emergency salvaging formula for treating difficult delivery.

9. Upbearing yang & boosting yin method
Upbearing yang and boosting yin is suitable in [case of] qi vacuity falling downward with simultaneous yin fluid insufficiency conditions. Master Fu used Sheng Jin Zhi Ke Yi Shui Yin (Engender Fluids, Stop Thirst & Boost Water Drink) for the treatment of postpartum vexatious thirst, inhibited urination and dry throat with a pale tongue, thin fur, and a fine, rapid pulse. [This is] due to postpartum loss of blood and sweat excessively consuming and damaging qi and yin, spleen and lung qi falling downward, and the bladder qi transformation losing its command. [Among] the medicinals used, Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), Sclerotium Poriae Cocos (Fu Ling), mix-fried Radix Glycyrrhizae (Gan Cao), Rhizoma Cimicifugae (Sheng Ma), and Radix Puerariae (Ge Gen) supplement the lung and spleen clear qi. Thus fluids are engendered and thirst is stopped, while transportation is regulated in the water passageways. Because yin fluids are insufficient, these are combined with uncooked Radix Rehmanniae (Sheng Di) and Tuber Ophiopogonis Japonici (Mai Dong) to nourish yin and engender fluids and thus stop oral thirst. Once the clear depurates water from its upper source, urination is disinhibited. This formula is categorized as Bu Zhong Yi Qi Tang combined with Sheng Mai San (Engender the Vessels Powder). Within this compound formula, there are many methods: upbearing yang and boosting yin, warming and clearing used simultaneously, all making a good [combined] strategy.The following essay is excerpted from The Essence of Liu Feng-wu's Gynecology, published by Blue Poppy Press. Liu Feng-wu is a very famous contemporary Chinese gynecological specialist. In this article, Liu explains what he sees as the most important of Li Dong-yuan's insights vis à vis the spleen and stomach and the wide-ranging ramifications of the spleen and stomach's functions to the other viscera and bowels.

"The Clinical Significance of the Spleen & Stomach's Upbearing & Downbearing"
by Liu Feng-wu

The spleen and stomach are connected to each other by a membrane and are located in the abdomen. One is a viscus, while the other is a bowel. They have an exterior-interior relationship and are the pivots of the qi transformation's upbearing and downbearing. The spleen governs movement and transformation, while the stomach rules reception and absorption. The spleen moves fluids and humors for the stomach, upbears the clear, downbears the turbid, and transports the finest essence of water and grains. It is the origin of the engenderment and transformation of qi and blood. If the stomach is strong and the spleen is fortified, water and grain qi is exuberant, essence is sufficient, and the spirit is effulgent. The qi mechanism flows smoothly and is harmonious. Thus the former heaven obtains nourishment, while the latter heaven obtains assistance. In addition, the spleen also has the important actions of boosting the qi, containing the blood, governing the muscles and flesh, and governing the four limbs. The spleen and stomach are also capable of conducting and abducting, transporting and transforming the dregs and the bowel qi via the large intestine, thus transforming the turbidity within the bowels and discharging toxic heat. Therefore, they are called "the latter heaven root.

I. The close functional relationship of the spleen & stomach's upbearing & downbearing
The spleen and stomach exist in a functional interrelationship vis à vis the dispersion and transformation [digestion] of water and grains and the assimilation and transportation of fluids and humors. The spleen resides in the central islet [i.e., the middle burner] in the interior which is categorized as yin. It stores and does not discharge. Therefore, the spleen is a yin viscus. However, its nature is to govern upbearing, and upbearing is yang. In order to upbear, it necessarily depends on yang qi. This is what transports fluids and humors upward. If the spleen does not upbear, it is of no use [i.e., it does not function], while if there is no yang, it cannot upbear. The spleen governs movement and transformation and produces stirring [i.e., activity]. Stirring is yang. Therefore, the spleen is yin in substance but yang in function. The stomach is categorized as a yang bowel. It discharges and does not store. Its nature is mainly downbearing. Downbearing is yin. Water and grains enter the stomach and obtain movement downward. All this depends on the stomach bowel's function of descending and downbearing. If there is no yin, there is no downbearing. If there is no downbearing, the bowel qi does not flow freely and the dregs are not descended. Hence, toxic, turbid substances are not transformed. Therefore, the stomach is yang in form but yin in function.

The spleen likes dryness and is averse to dampness, while the stomach likes moisture but is averse to dryness. Dampness is a yin evil. If damp evils are excessive, spleen yang suffers encumbrance and is not able to upbear. This then leads to the spleen's movement losing its command. If the stomach obtains dampness and moistening, it is able to descend and downbear. Dryness is a yang evil. If dry qi is excessively exuberant, this necessarily leads to yin qi being damaged. If yin qi is damaged, then it will lose its function of moistening and descending [or precipitating]. Therefore, in the Ye Tian Shi Yi An (Ye Tian-shi's Medical Records) it says:

If the spleen appropriately upbears, this leads to fortification, while if the stomach appropriately downbears, this leads to harmonization. When tai yin damp earth obtains yang, it can move. When yang ming dry earth obtains yin, it is quiet.

The spleen likes dryness, and the stomach likes moisture. However, this cannot be too excessive. If dry qi is excessive, this results in damaging the spleen's yang qi and consumes fluids and humors. If damp evils are excessive, this results in damaging the stomach's yang qi. Dryness and dampness are mutually antagonistic yet mutually co-productive, while functions of upbearing and downbearing are necessarily interdependent.

II. The relationship between the spleen & stomach's upbearing & downbearing and the other viscera

A. The liver & spleen
In "The Pulse Signs of the Viscera & Bowels, Channels & Network Vessels, and Former & Latter [Heaven] Diseases" in the Jin Gui Yao Lue (Essentials of the Golden Cabinet), it says:

When liver disease appears, know that the liver will conduct [the disease] to the spleen. Therefore, first replete [supplement or fortify] the spleen.

This is what is meant by reinstating the function of the spleen and stomach and secondarily treating liver disease. In order to treat the spleen, one should upbear. In order to treat the stomach, one should downbear. If the liver qi is depressed and bound, it may counterflow horizontally and first damage the spleen. Liver effulgence leads to gallbladder fire depression and binding. If this combines with the stomach qi, it leads to upward counterflow. Counterflow produces disease. It leads to the appearance of nausea, vomiting, a bitter [taste] in the mouth, and other such conditions. At the time of treatment, one should course the liver and resolve depression, orderly reach [i.e., free the flow of] the qi mechanism, and clear liver-gallbladder fire while also descending and downbearing the stomach qi and upbearing the spleen qi. Thus all such conditions can be eliminated. This is what is meant by treating the liver and secondarily treating the spleen.

Another example is liver effulgence and spleen vacuity. This results in the spleen qi not upbearing. [In that case,] necessarily there must be painful diarrhea. At the time of treatment, one should restrain the liver and fortify the spleen. The formula to use is Tong Xie Yao Fang (Painful Diarrhea Essential Formula). Within this, Radix Albus Paeoniae Lactiflorae (Bai Shao) harmonizes and restrains the liver. Radix Ledebouriellae Divaricatae (Fang Feng) courses the liver and upbears spleen yang. Rhizoma Atractylodis Macrocephalae (Bai Zhu) fortifies the spleen and supplements the qi. And Pericarpium Citri Reticulatae (Chen Pi) harmonizes the stomach. Thus liver depression is coursed and resolved, spleen qi obtains upbearing, and painful diarrhea is stopped automatically.

B. The heart & spleen
The heart stores the spirit, while the spleen governs thinking. Excessive thinking and worrying damage both the heart and spleen. If spleen qi depression endures, it leads to qi binding and non-obtaint of upbearing. If the heart qi becomes debilitated, the spleen qi easily suffers detriment and the muscles and flesh become emaciated. In gynecology, one commonly uses Gui Pi Tang (Restore the Spleen Decoction) in order to nourish the blood and supplement the heart, upbear the spleen and boost the qi. When the heart qi is nourished, it is able to resolve depression and binding. When depression and binding are resolved, spleen yang is upborne and flows smoothly. The qi is effulgent and blood is automatically engendered.

C. The lungs & spleen
The spleen governs the scattering [i.e., distribution] of essence which is upwardly transported to the lungs. If the spleen qi is effulgent and exuberant, the lung qi is full and sufficient. If the spleen qi is insufficient, the lung qi must be vacuous. Therefore, in order to treat the lungs, it is necessary to treat the spleen. The lungs govern the management and regulation and diffusion of fluids and humors. If the lung qi does not diffuse, it will be difficult for the spleen qi to upbear smoothly. Hence, within Si Jun Zi Tang (Four Gentlemen Decoction), Radix Panacis Ginseng (Ren Shen) supplements the lung qi, Rhizoma Atractylodis Macrocephalae (Bai Zu) supplements the spleen qi, and Sclerotium Poriae Cocos (Fu Ling) assists Atractylodes by fortifying the spleen and percolating dampness, while Radix Glycyrrhizae (Gan Cao) boosts the qi and supplements the center. Thus the spleen is fortified, the stomach is nourished, yang is upborne, and the qi is supplemented. If the lung qi is vacuous or there is lung consumption, vacuity detriment, or other such conditions, yin fluids may be insufficient and eating and drinking may be reduced and scanty. Then essence blood will be insufficient, and, in women, there will be blocked menstruation [i.e., amenorrhea]. Typically, this can be rapidly treated by supplementing both the lungs and spleen.

D. The spleen & kidneys
The kidneys are the viscera which store essence and are "the former heaven root." They are located in the lower burner. Therefore they are ultimate yin within yin. They store not only true yin but also true yang. The spleen [on the other hand] is the source of qi and blood and fluid and humor transformation and engenderment. It supplies the material basis for the continuous enrichment and engenderment of kidney yin and kidney yang. If kidney yang is insufficient, it may not be able to stir spleen yang. Hence spleen qi is not easily and smoothly upborne. If the spleen qi is weak, movement and transformation lose their duty and are not able to transport essence to the kidneys. This then results in kidney qi insufficiency. Thus the spleen and kidneys mutually enrich and assist one another. For example, Si Shen Wan (Four Spirits Pills) are said to mainly treat kidney diarrhea. However, within them, Fructus Psoraleae Corylifoliae (Bu Gu Zhi) supplements the fire of the gate of life; Fructus Evodiae Rutecarpae (Wu Zhu Yu) warms the center and dispels cold; Fructus Myristicae Fragrantis (Rou Dou Kou) moves the qi and disperses food, warms the center and rectifies the intestines; Fructus Schisandrae Chinensis (Wu Wei Zi) astringes yin and boosts the qi, secures and astringes and stops diarrhea; uncooked Rhizoma Zingiberis (Sheng Jiang) warms the center; and Fructus Zizyphi Jujubae (Da Zao) fortifies the spleen. Therefore, this formula warms the kidneys and warms the spleen, secures the intestines and stops diarrhea. The spleen and kidneys are both treated even though the treatment of the kidneys is the main [focus].

III. The clinical significance of the spleen & stomach's upbearing & downbearing

A. The internal link between the treatment of the spleen & the treatment of the stomach
The spleen and stomach have an interior-exterior relationship. If the spleen is diseased, the stomach is not able by itself to move fluids and humors. If the stomach is diseased, the spleen loses the place from which it receives its endowment. Therefore, diseases of the spleen and stomach are mutually interrelated. In clinic, one may see stomach disease accompanied by symptoms and signs of spleen disease. While if the spleen is diseased, one will see simultaneous signs of stomach disease. If [disease] manifests simply as spleen vacuity, the spleen can be heavily [i.e., greatly] supplemented. The formulas used are: Sheng Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder), Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction), etc. [However,] sometimes, the external manifestations seem to be due to spleen vacuity, yet their source is stomach disease. For instance, what looks like spleen vacuity diarrhea may be due to stomach stagnation downwardly disinhibiting the spleen qi. [In such cases,] heavy emphasis [on supplementation alone] is not able to treat the spleen. Instead, one should disperse food and abduct stagnation. When stagnation is removed, disinhibition will be stopped and the spleen qi will be able to obtain recovery. On the contrary, if scanty intake of food, dry mouth, heart fluster [i.e., palpitations], and shortness of breath are due to stomach stagnation torpid intake, then only using dispersing and abducting formulas will not be able to achieve the [desired therapeutic] effect. [In this case,] one should use Xiang Sha Liu Jun Zi Tang (Auklandia & Amomum Six Gentlemen Decoction), Wu Wei Yi Gong San (Five Flavors Special Effect Powder), etc. to mainly supplement the spleen. Then one will be able to affect a cure. Hence, it is very hard to separate fortifying the spleen from harmonizing of the stomach. What is necessary is to clearly divide the main from the secondary. Then stress should be laid accordingly so that one treats the root.

B. The dialectical relationship between upbearing yang & enriching yin
The relationship between upbearing yang and enriching yin is nothing other than the concrete measures adopted in clinic based on the inherent characteristics of the spleen's liking dryness and the stomach's liking moisture. It is also an apposite and united principle that suits the upbearing of spleen qi and downbearing of stomach qi. If the spleen is vacuous and the spleen qi does not upbear, then movement and transformation have no authority [i.e., power]. This then results in the appearance of venter chill and abdominal distention. Food enters but moves slowly and there is a preference for warm drinks. The stools are loose and the urination is clear and uninhibited. Women's menstruation is irregular or there may be flooding and leaking and abnormal vaginal discharge. If severe, qi vacuity may fall downward and the four limbs may lack strength. [There may be] shortness of breath, disinclination to speak, prolapse of the anus, etc. In that case, Wan Dai Tang (End Vaginal Discharge Decoction) is often used for treating women's spleen vacuity and damp stagnation, lassitude of the spirit, poor appetite, loose stools, swollen feet, and ceaseless vaginal discharge. Within this formula, Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Atractylodis (Cang Zhu), Pericarpium Citri Reticulatae (Chen Pi), and Radix Glycyrrhizae (Gan Cao) supplement the spleen and boost the qi, upbear yang and dry dampness, with upbearing of yang being the aspect that is stressed. At the same time, Radix Bupleuri (Chai Hu) and Herba Seu Flos Schizonepetae Tenuifoliae (Jing Jie Sui) are used to strengthen the action of upbearing yang and scattering dampness. Radix Albus Paeoniae Lactiflorae (Bai Shao) and Radix Dioscoreae Oppositae (Shan Yao) are used to enrich yin, harmonize the liver, and supplement the spleen. Semen Plantaginis (Che Qian Zi) disinhibits water and eliminates dampness. Thus, as a whole, this formula supplements and scatters (upbears), disperses (dries dampness) and upbears (yang), and supplements vacuity without stagnating evils. The dialectic relationship between upbearing yang and enriching yin should be dealt with correctly so as to make yang upbear and yin grow, yin engender and yang grow, and balance yin and yang.

As another example, for spleen vacuity accompanied by dampness and flooding and leaking downward bleeding [i.e., uterine bleeding], Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction) with additions and subtractions is often used. This boosts the stomach. When it is replete, it fortifies the spleen. Within this formula, Liu Jun Zi (Six Gentlemen [Decoction]) strengthens yang and boosts the stomach. To this is added uncooked Radix Astragali Membranacei (Huang Qi) in order to increase and strengthen the function of supplementing the qi and upbearing yang. Radix Bupleuri (Chai Hu) and Radix Et Rhizoma Notopterygii (Qiang Huo) upbear yang and scatter dampness. ([Dr. Liu] never gave up using them because they emit sweat and resolve the exterior.) These stress the aspect of upbearing yang. Radix Albus Paeoniae Lactiflorae (Bai Shao) restrains yin in order to harmonize the constructive. While Sclerotium Poriae Cocos (Fu Ling) and Rhizoma Alismatis (Ze Xie) disinhibit dampness and downbear turbidity. A small amount of Rhizoma Coptidis Chinensis (Huang Lian) is added to discharge and downbear vacuity fire. The above-mentioned formula and medicinals are the best examples of correctly dealing with the relationship between upbearing yang and enriching yin in association with the characteristics of upbearing the spleen and downbearing the stomach.

The stomach likes moisture but is averse to dryness and its nature is mainly downbearing. If there is dry heat in the stomach and yin fluids are insufficient, the throat will be dry and the mouth will be thirsty. Stomach grasping [i.e., the intake of food] will be devitalized. [In that case,] treatment should mainly clear (stomach) heat and nourish yin. For instance, in Sha Shen Mai Dong Tang (Glehnia & Ophiopogon Decoction), Radix Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonici (Mai Dong), Rhizoma Polygonati Odorati (Yu Zhu), and Radix Trichosanthis Kirlowii (Tian Hua Fen) are ingredients which clear heat and moisten dryness, engender fluids and nourish yin, heavily moistening and downbearing. These are combined with Semen Dolichoris Lablab (Bian Dou) and Radix Glycyrrhizae (Gan Cao), which boost the qi and harmonize the center, and Folium Mori Albi (Sang Ye), which lightly diffuses, upbears, and scatters, in order to upbear, diffuse, and strengthen the spleen.

As another example, due to dry evils damaging yin, a woman's menstruation may become blocked because her blood is vacuous and her fluids are debilitated. [In that case,] it is OK to use San He Tang (Triple Combination Decoction, i.e., the combination of Tiao Wei Cheng Qi Tang, Regulate the Stomach & Order the Qi Decoction, Liang Ge San, Cool the Diaphragm Powder, and Si Wu Tang, Four Materials Decoction). When dry heat obtains clearing, yin fluids will recover. When the stomach obtains downbearing, spleen qi obtains upbearing. The chong [penetrating] and ren [conception or controlling] vessels and pathways become freely flowing and uninhibited, and the menstrual water becomes self-regulated.

Yet another example from gynecology is that, during a warm heat disease, there may sometimes appear a bowel repletion condition. Internally, heat accumulates and is exuberant. [In that case,] one should use Da Cheng Qi Tang (Major Order the Qi Decoction) with additions and subtractions to urgently precipitate. This will free the flow and downbear dryness and heat. The result will be the engenderment of fluids and the preservation of yin. Sometimes there may be blood vacuity blocked menstruation. [In that case,] one should use Gui Pi Tang (Restore the Spleen Decoction) to treat it. Wishing to downbear, first upbear. Wishing to free the flow, first supplement. When yang is upborne and the blood is sufficient, the chong and ren will be full and exuberant, and hence the menstrual blood will automatically be free-flowing. Thus, the aim lies in correctly dealing with the dialectic relationship between upbearing yang and enriching yin no matter whether urgently precipitating to preserve yin, using sweet, moistening [medicinals] to increase fluids or upbearing yang and boosting the qi. When yang is upborne, yin grows.

Therefore, the medical experts who have discussed [and based treatment on] the spleen and stomach are very many. Their experiential knowledge based on clinical practice can be summarized thus: The spleen and stomach have an interior-exterior relationship. One is yin and one is yang; one upbears and one downbears; and they function interdependently. The spleen is a yin viscus but its function is yang. Without upbearing, yang cannot function. [Therefore,] for yang to function, one must upbear. The stomach is a yang bowel but its function is yin. Yin governs downbearing. If there is no downbearing, yin cannot function. Thus, in treating the spleen, one must know how to promote upbearing, while in treating the stomach, one must know how to promote downbearing. Only if one observes yin and yang, knows upbearing and downbearing, and is clear about supplementing and discharging is one able to grasp the key point of spleen and stomach function.

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